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NHSX Director - “Those legacy systems exist for a reason”

Dr Sam Shah, Director of Digital Development at the recently created central digital unit for the NHS - NHSX - spoke about the need to include all users in the digital changes across the health service.

The National Health Service’s newly formed digital unit - NHSX - is working closely with a broad spectrum of users to get a better sense of how it can guide digital change across the system - recognising that the legacy systems that are in place, do serve a purpose. The balanced view is likely to be welcomed by healthcare professionals who in the past have had to deal with central, top-down initiatives that attempted, and failed, to drive radical change.

Dr Sam Shah said that NHSX needs to be conscious of the historic culture that exists within the NHS and think about how to change and guide it through complex digital programmes. Shah was speaking this week at Disruption Summit Europe in central London.

NHSX formally opened its doors over the summer, where former Director General for DCMS, Matthew Gould, was announced as its CEO. Since then we have slowly been learning about the organisation’s ambitions, which include introducing spend controls, adopting open standards and guiding policy.

The NHS has a particularly brutal past when it comes to technology delivery, most notably where the National Programme for IT saw billions of pounds wasted for very little in return. One of the key problems with past efforts is that the NHS is an incredibly fragmented organisation, often catering to local needs, and an ‘ivory tower’ approach doesn’t seem to work.

Dr Shah said:

We deal with 1.4 million patient encounters every single 24 hours. So there's a lot of people we come into contact with. And if we think about the journey of digital transformation, it's happened in various forms over time within the NHS - there has been lots of stories out there about what's worked, what hasn't.

NHSX is really there to bring together the strategy, the policy, and all of that digital transformation in the health system. And it really is there to try and help set the agenda across the system, bring about some of the change, but more importantly, focus on a set of missions that are important to the population out there.

And the population, I mean, the clinicians, all the workers in health care, and most importantly, the patients and the citizens that use our services. And ultimately, NHSX is there to try and bring the transformation that will change their lives and improve their outcomes.

Including everyone

Wisely, Dr Shah recognises that if NHSX is going to make an impact it needs to not just focus on technology as an outcome, but place importance on the people and culture change required to make a difference. He said that NHSX is focusing on how it can get its mission out to users and make them part of the process, so that the people working across the NHS become NHSX’s “agents for change”.

There's lots of different ways that's happening. Part of that is embedding these researchers into other policy teams around the system. Some of it is working across our other organisations in the NHS. More importantly, it is this cultural shift.

Because at the moment, if I take the culture of the NHS, it's one that's historic, it means something nationally, There's a lot of love for the NHS, which is an important thing. And we have a lot of users. And against that, we have to try and balance what we want to do with service design. Because those legacy systems exist for a reason. They exist because people's needs are being met in a certain way.

He added that the NHSX team is spending a lot of time ‘on the ground’, working with clinicians and people working with the systems currently in place, to understand what works and what doesn’t. Dr Shah said:

And if we move into the current space, we need to meet people's needs in a slightly different way. Or they might be demanding services in perhaps a more digital way. We have to really think carefully about what the impact might be of service design and transformation and the impact on users.

And so one of the ways we're doing that is bringing users into user labs. So some of the services we're designing they’ve been very much part of it. We have user researchers, who are going out to meet users, right in the environment there. They're waiting in the waiting room, in the A&E. They might be waiting for procedure somewhere. They might be sitting in the GP practice to go and really see those people.

People go follow clinicians to see what they're doing, what buttons they click, what works, what doesn't. And that's really important, because in the centre we can all sit there and think everything works - but actually you go on the ground and that kit we are putting out there, people aren’t using it.

Diversity and inclusion is on the agenda

It was also really great to hear Dr Shah talk about diversity and inclusion being top of the agenda for NHSX. We at diginomica have long written about the importance of D&I, in terms of workforce wellbeing, but also in terms of enabling better services to reflect the societies and communities being served. This is important for private companies, but it’s critical for public services. Dr Shah said:

It’s a really, really important agenda for me. I think diversity and inclusiveness and decision making is an important part of, not just the NHS, but also the way that we work and deliver with digital transformation. And that involves everything. From ensuring that we've got a wide range of users across the spectrum involved in some of that decision making.

And also the way that we run our teams. So one thing I'm really keen on is ensuring that the teams that I recruit are incredibly diverse, from all spectrums in society. Because by doing that, I think we’ll end up with better decision making of what we have in public sector, particularly in health.

It's not something that has always been right in health service. I think it's fair to say there's quite a few reports about low levels of diversity and seniority in the health service. But that's beginning to change. And it will only happen if we keep on promoting the people, giving them opportunities and developing that talent.